Acquired Myopic Shifts

Hello, welcome to I3Ears, they're off the Mulsio Ocaps and Board of View podcasts. We're our host Ben Young. And Amanda Redfern. This week we are going to start our World Board of View series by presenting a common topic that might be covered by the boards and then going through the differential, showing you how we would go through the differential diagnosis. So what are we going to talk about this week, Amanda? So this week we're going to take the very classic topic of an acquired myopic shift. We're not going to present a specific example, but hopefully the case will be something along the lines of they became more minus in the prescription over some period of time. And then they may show a picture or they may not even show a picture for that and then you would just have to go through the differential diagnosis. I mean, what is your approach for this kind of differential diagnosis? So I like this as a classic case because you can take the approach of going through a differential from front to back, which gives you good system for doing it in a very short period of time, which is what you're dealing with on the oral boards. That's the way I deal with at least these refractive shift cases. Yeah, I think for a lot of cases, it's great to have that structure. Even if you don't decide to go into your post year, you might go system space, like the vitamin C, an amonic or something, but you got to have a structure. Otherwise, you're definitely going to forget things, I think. If you have an amonic, that's great too. But we didn't have that. Not everything's amenable to an amonic, but when they are, it's so sweet. So amenable to an amonic, that's what we should have renamed the podcast too. Okay, so starting in the front of the eye, where could your myopic shift be? So starting with the cornea, an acquired myopic shift would come from keratoconus. Yeah. That could either be your classic keratoconus or even having just a post refractive acthesia. And then the next thing that we would hit is the interior chamber, but there's nothing much specifically in the AC that would cause myopic shift. So then we can move on to the lens, which is connected to the sensory body. And this is where the lion's share of our myopic shift stuff is. So one obvious one, probably the most common one is cataract progression, you know, progressing in a nucleic chloride, a cataract can give you myopic shift. But that's not, don't stop there. So, oh, it else could there be amanda? Well, what about all our patients with diabetes? So we often kind of talk about this in clinic, as a reason for changes in it comes from the lenticular adema with the hyperglycemia. Yeah. That's a critical one. Remember the presence I work with will remember, will know that I was like raving about this because there was a patient that I'd seen who had lenticular adema. And it, well, myopic shift turned into lenticular adema. And that's how their pancreatic neuroendocrine tumor was found. Wow. Yeah. Like they had new, like they did not know how they had diabetes. And then I CT eventually show that they had diabetes because it's pancreatic. Your endocrine tumor, etc. So like, now that is probably too deep. Like that, like you're not going to be question much. I don't think about pancreatic neuroendocrine tumors. But you know, that that's how myopic shift could, you know, this is one of those like could kill you if you don't recognize diabetes, differentials. Another thing is a accommodative spasm. That's definitely something that needs to be considered. One possible cause that I would be a traumatic accommodative spasm. These are like the kids coming into the ED after like getting knocked in the head, playing football. Right. And their vision is suddenly really blurry. And then all of a sudden you give them the phenyl and tripeck, specifically the tripeck and they can see better. Yeah. And this is not like traumatic iridesist. You know, it's not like spasm a silvery body from that. So okay. And then there are medications that can affect the lens or silvery body. What might those be? Anithistines being a common one and topear may being a very classic testable medication. Yeah. And that can cause uviel fusions that can rotate the silvery body anteriorly which can induce myopia. That's another very real thing that you can't miss. I feel like topear made is like the most heated oral medication in glaucoma because I felt like it was peppered in the glaucoma vcsc. Yeah. There's like many things in there. But okay. I like topear made a lot because it's helpful for I.H. Yeah. I know that you're up to most is like to prescribe it a lot but you know it can cause problems like myopic shift. And is that it? Do we want through the lens? We're done with this episode. What about the lie? There's a rest. Well, okay. So the vitrious cavity, there's not really that much in the vitrious cavity that can results in myopic shift. But I guess now if we keep going back then there's supposed to your scleran. I think this is where people it's easy to forget things on your differential. So what with the sclera can lead to myopic shift? Well, when people like bend get their hands on you, sometimes you can wind up with a scleral buckle. So that could be a way to acquire myopic shift. I don't think that the boards are usually going to be tricky in that like oh the patient has like a recent surgery and didn't tell you but you know you got to keep that in a differential in case that comes up as part of the rest of the question stem. I don't think that is sort of related is a staph aloma. So to remind you that's usually patients with high myopia, the posterior your pole can bulge out posteriorly and it can continue to bulge out over life and I can give you an acquired myopic shift as well. And younger or earlier in life, congenital glaucoma can change your axial length so they can get an acquired myopic shift as well. Yeah, especially you can have that more of that pediatric population. Okay, now that is basically the differential for my opic shift. So I mean, do you want to just list them off one more time in order so that our reviewers can remember that? So from front to back, cornea you can get keratoconis and actasias for your lens and ciliary body. There's cataract progression, lenticular dima from diabetes, accommodative spasm and medications, including anti-histamines into a pure mate. And then the globe as a whole, you can get progressive staph aloma, changes from sclerobuckle surgery and congenital glaucoma, which will change your axial length or can change your axial length. And that's it. We're hoping that these episodes are kind of shorter and sweeter. If you liked what you heard, leave us a review on Twitter and not Twitter. If you like what you heard, leave us a review on iTunes or we found us. And you know, if you'd like to support the podcast, you can fall us Twitter at i4 years within number four. You could also tweet a feedback on how you would like these episodes to go what would be the most helpful format for you. Yeah, you know, we'd love to make oral board view a little bit easier and provide another, you know, freely available resource given how expensive oral board review and the, you know, acquisition of test materials can be. So anything we can do to make these better, we'd love to hear from you. Otherwise, we'll see you guys next week. Bye. Bye. 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